It's the beginning of August. It's hot and sunny. The days are still long and the pool is still open. You might not want to think about the coming of the colder months, but if you're one of the 6% of Americans who suffer from Seasonal Affective Disorder (SAD) or one of the additional 14% of Americans who suffer from the less severe version, called the "winter blues", now is the time to work on managing that seasonal dip in mood.
Why start now?
The days have been getting shorter for over a month now. In addition, August is the time that many Americans experience an increase in stress, especially those who work in academic settings or who have children in school. Beginning to use good coping strategies now can be more helpful than starting those strategies once you're already noticing your seasonal mood symptoms.
Coping Strategies by Symptom
You sleep much more than usual in the winter.
One sign of seasonal depression include sleeping more than usual during the winter months. Most people do sleep more than usual, but within an hour of their normal sleep duration. Those with SAD sleep on average 2.5 hours more than in the summer months, and those with winter blues sleep 1.7 hours more.
Consider using a therapeutic lamp. Set up the lamp somewhere you will find it convenient to use it daily for 20-30 minutes. It needs to be a very bright (10,000 lux) lamp that can be used at a comfortable distance (some smaller lights need to be very close to you in order to expose you to the proper amount of light.) Start using it now, before the days become short and your symptoms become noticeable. The best time to use it is first thing in the morning. If you want, you can even plug it with a smart plug and set it to wake you up in the morning (it's very bright, so this will be somewhat of a rude awakening, but you're pretty much guaranteed not to sleep in!)
Note: if you have been diagnosed with a bipolar mood disorder, you should talk to your psychiatrist about the risks of using light therapy. In those with bipolar mood illness, light therapy can trigger a manic episode.
You feel sad, irritable, or anxious in the fall or winter months.
The mood symptoms associated with seasonal changes can vary from person to person. While low energy and sadness are common, anxiety and irritability are also observed.
Exercise is a very good way to counteract low mood. Daily exercise in the morning can help wake you up and get you energized for the day. If the morning feels too hard, exercising in afternoon or early evening can help boost your mood later in the day. Aerobic exercise is particularly good for anxiety and irritability. Strength training has been shown to improve mood and self-esteem.
One particularly powerful use of exercise is to combine it with volunteering. Try signing up for a physically active volunteering program like our local City Snow Partners, which brings together volunteers with local households in need of snow removal. Or just take a walk around your own neighborhood and see who might need their leaves raked or snow shoveled.
You avoid friends and family.
If you're isolating yourself in the winter months, you're not alone. When the evenings get darker and the weather gets colder, we all tend to spend less time socializing with others.
n the summer months, social activities abound. But as it gets colder, you have to make a conscious effort to stay social. This is particularly true for introverts, who want nothing more than to spend an evening at home with a book. If that's you, it's okay to indulge in some quiet evenings. Try to strike a balance, planning for a few different social outings each week, alternated with days at home. Recurrent social engagements, like book clubs, bowling leagues and church functions help to keep you in a routine of being social. For days when you're feeling like you'd rather not go, just make a deal that you'll attend the first half hour of a social event. Once you're there, you may feel like staying.
You turn to food for comfort
It's natural to have a craving for carb-dense foods in the autumn months, leading up to a time when food used to be much more scarce. This can lead to eating processed foods that lead you to feel more fatigued and foggy-headed.
Look for comfort foods that are consistent with a healthy diet. Dr. Andrew Weil's anti-inflammatory food pyramid is a good place to start, in terms of finding foods that will promote, rather than detract, from our overall health. Small changes can lead you to feel much better, such as swapping a baked sweet potato for fries, or guacamole for cheese dip. Having a baked apple with cinnamon, or a pumpkin custard, make great fall desserts. If this is a particular area of struggle for you, you may want to consult with a local dietitian to help you adapt your favorite comfort foods to healthier versions. No matter what diet you're choosing, mindful eating strategies are also important. Mindful strategies include: eat only when you're hungry, eat slowly, enjoy each bite and stop when you are no longer hungry.
You're drinking more than usual.
When the days get shorter, we reach for things that will boost our sense of pleasure. If you're reaching for alcohol, it's important to check in to see if your drinking is reaching a problematic level. The CDC considers moderate drinking up to 1 drink a day for women and up to 2 drinks a day for men. It's important to note that many mixed drinks contain much more than one drink's worth of alcohol. You might be surprised to learn how little alcohol the average American drinks, with 60% of Americans drinking one drink or less per week.
What's the harm in drinking? Heavy drinking makes depression worse over time. Those who drink often find their anxiety has worsened by the next morning, leading to an increased urge to drink again the next day. Drinking can drive a wedge between you and your partner, or between you and your children. Over time, drinking can lead to serious health, legal and financial consequences.
Changing alcohol habits can be easy for some and nearly impossible for others. If you feel you may need help, find a local AA chapter, or look into the Smart Recovery program for a secular alternative to AA. If you have a loved one who drinks, consider going to Al-Anon, a support group for friends and relatives of alcoholics.
Serious symptoms, like loss of appetite, suicidal thoughts, severe insomnia or panic attacks.
For some, seasonal depression reaches a moderate to severe level. If you're noticing that you're having trouble eating, you're having persistent difficulty sleeping, your having panic attacks or thoughts of self-harm, it's time to seek professional help. Find a therapist who can help you address the behavioral aspects of this condition and consider scheduling with a medical doctor to get a physical exam and medication consultation.
Tis the season to rack your brain trying to come up with gift ideas for your loved ones. If you’re hoping that 2018 will bring more peace and good health, consider these gift ideas:
Helko Vario 2000 Heavy Log Splitter
Call it Lumberjack Therapy. There is something very peaceful and rewarding about spending time outdoors splitting wood. Heave this solid axe in the air and bring it down hard to crack and split large logs. After a few minutes, you’ll need to remove your coat, as splitting wood is great exercise, which helps to burn off stress hormones in your body. After a little bit of practice, you’ll feel proud of your ability produce a satisfyingly tidy pile of wood. Splitting wood gives you solitude, time in nature, productivity and exercise all in one. The particular axe listed above, and similar axes like the Finnish Leveraxe, make wood splitting much easier and, thus, more accessible to those of us without burly lumberjack physiques. Of course, if your loved one does have a burly lumberjack physique, you may be able to get by with a less expensive model.
Massage Gift Certificate
Say all you want about the benefits of psychotherapy, a good massage can be just as beneficial. Besides, it’s just not appropriate to give a loved one a gift certificate for psychotherapy. Even if they could use it. Instead, give your loved one the gift of a relaxing massage. If a massage isn’t in your budget, consider getting gift certificates from a beauty school, where discounted massage is available.
A Good Read
Winter is the perfect time to curl up with a good book. And, what’s better than a good book with a good message? Give your loved one the gift of inspiration and hope in the form of a book about Paul Farmer, a doctor who is working to cure our global health system. While you’re at it, donate in your loved one’s name to Farmer’s world-changing organization, Partners In Health.
Cell Phone Cozy
There isn’t much worse for your mental health than your own cell phone. Cell phones bring the stress of work, world events and internet trolls into every moment of your day. Buy your loved ones one of these cute, made in America, crocheted owls to cover their phone. Then, hide their phone so they can’t locate it again.
Yes, that’s right, the gift of nothing could be the very best thing to give your loved ones in 2017. If you’re like many Americans, you, and your loved ones, have all your basic needs met. So, just give your loved ones a hug, play a game of cards with them or do their dishes. If you have money burning a hole in your pocket, give to those less fortunate, both here and abroad.
I used to view the month of January as a nemesis. I viewed it as a cold, dark month bereft of any good holidays or other redeeming features. When the calendar would roll around to the month, I'd grit my teeth and tell myself that, once the month was over, I'd gotten past the worst of winter. At best, I viewed it as a challenge to be overcome.
Several years ago, I decided that I'd had enough of hating January. I decided to shift my thinking about it. After all, the hours of sunlight are increasing all month. For that reason, I labeled January as the start of "very early spring." I began to use the month to do a deep "spring cleaning" and rearranged my home. Once I was done with that, I treated myself to pouring over seed catologs and planning my garden. Before I knew it, January was starting to grow on me. I began to look forward to the month. Now, it feels like this great opportunity to get a fresh start and an early jump on spring.
What's your least favorite month? Can you think of a way to reframe it? Or, at least, better ways to care for yourself during that month? Some ideas:
1) Make a list of projects to save for that month (e.g. reorganizing the attic, refinishing a piece of furniture, going through closets for items to donate.)
2) Find ways to keep your body moving, regardless of the weather. Exercise is an essential part of good mental health. Think about joining a gym or buying some exercise equipment for home.
3) Find positive associations for the month. Maybe you love reading. Make yourself a cozy reading spot and a list of books to read. Buy some tea or snacks. If you're a gardener, like me, sign up to get some new seed catologs. No interests coming to mind? Maybe you could use the month to start a new hobby. Consider trying my husband's 28 day challenge.
4) Get outdoors. This is a hard one, but a little time in nature does a lot of good. It's easy to talk yourself out of going for a walk if you're not properly dressed for the weather. Invest in some clothes that work for your hard month.
5) Practice self-acceptance. You may not totally succeed in finding a way to enjoy your tough month. You may fall short of your goals for exercise or getting outdoors. That's okay. Criticizing yourself will only make you less likely to succeed. Instead, revise your goals and re-dedicate yourself to good self-care.
For some, seasonal changes trigger more than the blues or irritabilty. If seasonal changes trigger moderate to severe mood or anxiety issues for you, please seek help from a mental health professional. Anniversaries of loss and trauma can contribute to this. Working with a therapist can help you understand your seasonal triggers and better overcome them.
A study that was presented at the American Society of Anesthesiologist's Annual Meeting last month has been widely promoted as linking the use of epidural anesthesia to a lowered risk of postpartum depression. The idea that opting for an epidural could reduce the risk of a serious postpartum complication is an appealing one. Unfortunately, as with many popular reports of scientific findings, secondary sources have put an inaccurate spin on the findings.
In this study, only women who received epidurals were included. The amount of pain relief provided by the epidural was related to postpartum depression scores on the Edinburgh Postnatal Depression Scale (EPDS.) The study showed that women who got significant pain relief were less likely to have an elevated EPDS score than women who got less relief from their epidural. What this study suggests is the effectiveness of the epidural is inversely correlated with postpartum depression scores (i.e. better pain relief, less depression.) This makes sense. If a woman is in enough pain to request an epidural, and does not get good pain relief from it, it is likely that she will experience one of the major risk factors for postpartum depression: an emotionally traumatic birth. Rather than suggesting that epidurals reduce the risk of postpartum depression, we could say this study suggests that failed epidurals increase the risk of postpartum depression.
What this study does not show is that getting an epidural is going to reduce your likelihood of postpartum depression. Why? Because the study was limited only to women who got an epidural, excluding those who chose an unmedicated birth. Another, larger study found the opposite association: women who got an epidural had a higher likelihood of postpartum depression than women who did not.
What's a mother to believe? The issue is that it is very difficult for us to study the impact of epidurals. The gold standard of research, the randomized study, would not appeal to many women. Nor would it be particularly ethical or safe. So, when we look at epidural use, we face a number of confounds in the research. Women who seek an epidural may have pre-existing conditions or labor complications that are absent in women who have unmedicated births. Because of this, we can't be completely sure if outcomes associated with epidural anesthesia are due to the anestheisa itself or to another condition.
So, what should women know about getting an epidural? Simply, epidurals have risks and benefits. The risks include longer labor, more cesarean births and greater risk of perineal laceration (a.k.a. tearing your lady parts.) You can end up with an epidural that doesn't work, or only works on one side. You have a small (1.5%) chance of developing headaches due to an accidental misplacement of the injection. It is certain that use of an epidural impairs mobility during labor, making it harder to get in an ideal position for birth. Epidurals also impair mobility after labor, making it harder to parent in those early hours of motherhood. The benefits of epidurals are obvious: pain relief & the ability to rest. The reduction or elimination of pain during childbirth is an important choice for women to have, especially when used wisely (i.e. later in labor and when other methods of pain relief have been exhausted.)
Working with pregnant and postpartum women, I often hear feelings of disappointment, even shame, about the use of an epidural during labor. What every woman needs to know: labor and childbirth are not designed as a test of your strength or determination. They are, simply, a way to deliver your child into your arms. Surround yourself with people who support the birth you want. Prepare yourself to have the healthiest birth you can. Make peace with the birth you have. If you find yourself having trouble processing your feelings about childbirth, find someone you trust to talk to about this. Postpartum Support International can help you find a professional or support group near you.
Sarah L. Wesch, Ph.D.